Epidemiological analysis on two decades of hospitalisations for meningitis in the United States

  • P. Pellegrino
  • C. Carnovale
  • V. Perrone
  • D. Salvati
  • M. Gentili
  • T. Brusadelli
  • S. Antoniazzi
  • M. Pozzi
  • S. Radice
  • E. Clementi
Article

Abstract

Bacterial meningitis is an important source of mortality and morbidity worldwide. Data exist on specific vaccines against Streptococcus pneumoniae and Neisseria meningitidis indicating that they reduce the incidence of meningitis, yet comprehensive information on the trend of bacterial meningitis is still lacking. We analysed the Kids’ Inpatient Database and the National Inpatient Database considering all bacterial meningitides in the United States, excluding cases of tuberculosis and sexually transmitted diseases. We analysed the trend of meningitis incidence from 1993 to 2011 and in specific age groups before and after the introduction of the pneumococcal conjugate vaccine 7 (PCV-7) and the meningococcal conjugate vaccine 4 (MCV-4). Moreover, we analysed the prevalence of aetiological agents to assess their changes. We estimated 295,706 cases of meningitis having occurred in the United States and a reduction of the discharge rate of 21 %. We observed a significant reduction in cases of meningitis in children and elderly patients following the introduction of the PCV-7. We also found a reduction in subjects aged 10–14 years, an age span consistent with the introduction of MCV-4, although further analyses based on serotypes data are required to confirm this observation. By contrast, we observed an increased prevalence of cases of staphylococcal and streptococcal meningitides. The introduction of PCV-7 has reduced the incidence and changed significantly the aetiology of bacterial meningitis in the United States during the last two decades.

References

  1. 1.
    Nudelman Y, Tunkel AR (2009) Bacterial meningitis: epidemiology, pathogenesis and management update. Drugs 69:2577–2596PubMedCrossRefGoogle Scholar
  2. 2.
    Wenger JD, Hightower AW, Facklam RR, Gaventa S, Broome CV (1990) Bacterial meningitis in the United States, 1986: report of a multistate surveillance study. The Bacterial Meningitis Study Group. J Infect Dis 162:1316–1323PubMedCrossRefGoogle Scholar
  3. 3.
    Schuchat A, Robinson K, Wenger JD, Harrison LH, Farley M, Reingold AL, Lefkowitz L, Perkins BA (1997) Bacterial meningitis in the United States in 1995. Active Surveillance Team. N Engl J Med 337:970–976PubMedCrossRefGoogle Scholar
  4. 4.
    Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, Harrison LH, Farley MM, Reingold A, Bennett NM, Craig AS, Schaffner W, Thomas A, Lewis MM, Scallan E, Schuchat A; Emerging Infections Programs Network (2011) Bacterial meningitis in the United States, 1998–2007. N Engl J Med 364:2016–2025PubMedCrossRefGoogle Scholar
  5. 5.
    von Gottberg A, Cohen C, Whitelaw A, Chhagan M, Flannery B, Cohen AL, de Gouveia L, Plessis Md, Madhi SA, Klugman KP; Group for Enteric, Respiratory, Meningeal Disease Surveillance in South Africa (GERMS-SA) (2012) Invasive disease due to Haemophilus influenzae serotype b ten years after routine vaccination, South Africa, 2003–2009. Vaccine 30:565–571CrossRefGoogle Scholar
  6. 6.
    Musher DM (2006) Pneumococcal vaccine—direct and indirect (“herd”) effects. N Engl J Med 354:1522–1524PubMedCrossRefGoogle Scholar
  7. 7.
    Hsu HE, Shutt KA, Moore MR, Beall BW, Bennett NM, Craig AS, Farley MM, Jorgensen JH, Lexau CA, Petit S, Reingold A, Schaffner W, Thomas A, Whitney CG, Harrison LH (2009) Effect of pneumococcal conjugate vaccine on pneumococcal meningitis. N Engl J Med 360:244–256PubMedCrossRefGoogle Scholar
  8. 8.
    Duggan ST (2010) Pneumococcal polysaccharide conjugate vaccine (13-valent, adsorbed) [prevenar 13®]. Drugs 70:1973–1986PubMedCrossRefGoogle Scholar
  9. 9.
    Centers for Disease Control and Prevention (CDC) Immunization schedules. Available online at: http://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. Last accessed 3 March 2014
  10. 10.
    Cohn AC, MacNeil JR, Harrison LH, Hatcher C, Theodore J, Schmidt M, Pondo T, Arnold KE, Baumbach J, Bennett N, Craig AS, Farley M, Gershman K, Petit S, Lynfield R, Reingold A, Schaffner W, Shutt KA, Zell ER, Mayer LW, Clark T, Stephens D, Messonnier NE (2010) Changes in Neisseria meningitidis disease epidemiology in the United States, 1998–2007: implications for prevention of meningococcal disease. Clin Infect Dis 50:184–191PubMedCrossRefGoogle Scholar
  11. 11.
    Centers for Disease Control and Prevention (CDC) Meningococcal vaccine for preteens and teens. Available online at: http://www.cdc.gov/vaccines/who/teens/vaccines/mcv.html. Last accessed 3 March 2014
  12. 12.
    HCUPnet. Home page at: http://hcupnet.ahrq.gov/HCUPnet.jsp. Last accessed 24 September 2013
  13. 13.
    Griffin MR, Zhu Y, Moore MR, Whitney CG, Grijalva CG (2013) U.S. hospitalizations for pneumonia after a decade of pneumococcal vaccination. N Engl J Med 369(2):155–163PubMedCrossRefGoogle Scholar
  14. 14.
    Lindenauer PK, Lagu T, Shieh MS, Pekow PS, Rothberg MB (2012) Association of diagnostic coding with trends in hospitalizations and mortality of patients with pneumonia, 2003–2009. JAMA 307:1405–1413PubMedCrossRefGoogle Scholar
  15. 15.
    Bogaert D, Hermans PW, Boelens H, Sluijter M, Luijendijk A, Rumke HC, Koppen S, van Belkum A, de Groot R, Verbrugh HA (2005) Epidemiology of nasopharyngeal carriage of Neisseria meningitidis in healthy Dutch children. Clin Infect Dis 40:899–902PubMedCrossRefGoogle Scholar
  16. 16.
    Gallup. U.S. smoking rate still coming down. Available online at: http://www.gallup.com/poll/109048/us-smoking-rate-still-coming-down.aspx. Last accessed 24 September 2013
  17. 17.
    Harrison LH (2010) Epidemiological profile of meningococcal disease in the United States. Clin Infect Dis 50(Suppl 2):S37–S44PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Schlech WF 3rd, Ward JI, Band JD, Hightower A, Fraser DW, Broome CV (1985) Bacterial meningitis in the United States, 1978 through 1981. The National Bacterial Meningitis Surveillance Study. JAMA 253:1749–1754PubMedCrossRefGoogle Scholar
  19. 19.
    Marom T, Tan A, Wilkinson GS, Pierson KS, Freeman JL, Chonmaitree T (2014) Trends in otitis media-related health care use in the United States, 2001–2011. JAMA Pediatr 168(1):68–75PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Tan TQ (2012) Pediatric invasive pneumococcal disease in the United States in the era of pneumococcal conjugate vaccines. Clin Microbiol Rev 25(3):409–419PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • P. Pellegrino
    • 1
  • C. Carnovale
    • 1
  • V. Perrone
    • 1
  • D. Salvati
    • 1
  • M. Gentili
    • 1
  • T. Brusadelli
    • 1
  • S. Antoniazzi
    • 3
  • M. Pozzi
    • 2
  • S. Radice
    • 1
  • E. Clementi
    • 1
    • 2
  1. 1.Unit of Clinical Pharmacology, Department of Biomedical and Clinical SciencesUniversity Hospital “Luigi Sacco”, Università di MilanoMilanItaly
  2. 2.Scientific Institute, IRCCS E. MedeaBosisio PariniItaly
  3. 3.IRCCS Foundation Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly

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